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Review
. 2023 Feb 8;12(2):273.
doi: 10.3390/biology12020273.

New Psychoactive Substances Intoxications and Fatalities during the COVID-19 Epidemic

Alfredo Fabrizio Lo Faro  1 , Diletta Berardinelli  1 , Tommaso Cassano  2 , Gregory Dendramis  3 , Eva Montanari  1 , Angelo Montana  1 , Paolo Berretta  4 , Simona Zaami  5 , Francesco Paolo Busardò  1 , Marilyn Ann Huestis  6
Affiliations
Review

New Psychoactive Substances Intoxications and Fatalities during the COVID-19 Epidemic

Alfredo Fabrizio Lo Faro et al. Biology (Basel). .

Abstract

In January 2020, the World Health Organization (WHO) issued a Public Health Emergency of International Concern, declaring the COVID-19 outbreak a pandemic in March 2020. Stringent measures decreased consumption of some drugs, moving the illicit market to alternative substances, such as New Psychoactive Substances (NPS). A systematic literature search was performed, using scientific databases such as PubMed, Scopus, Web of Science and institutional and government websites, to identify reported intoxications and fatalities from NPS during the COVID-19 pandemic. The search terms were: COVID-19, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019, intox*, fatal*, new psychoactive substance, novel psychoactive substance, smart drugs, new psychoactive substance, novel synthetic opioid, synthetic opioid, synthetic cathinone, bath salts, legal highs, nitazene, bath salt, legal high, synthetic cannabinoid, phenethylamine, phencyclidine, piperazine, novel benzodiazepine, benzodiazepine analogue, designer benzodiazepines, tryptamine and psychostimulant. From January 2020 to March 2022, 215 NPS exposures were reported in Europe, UK, Japan and USA. Single NPS class intoxications accounted for 25, while mixed NPS class intoxications represented only 3 cases. A total of 130 NPS single class fatalities and 56 fatalities involving mixed NPS classes were published during the pandemic. Synthetic opioids were the NPS class most abused, followed by synthetic cathinones and synthetic cannabinoids. Notably, designer benzodiazepines were frequently found in combination with fentalogues. Considering the stress to communities and healthcare systems generated by the pandemic, NPS-related information may be underestimated. However, we could not define the exact impacts of COVID-19 on processing of toxicological data, autopsy and death investigations.

Keywords: COVID-19; fatalities; intoxications; new psychoactive substances.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prisma flowchart of the literature search on NPS intoxications and fatalities cases during the pandemic period (January 2020–March 2022).
Figure 2
Figure 2
Number of single- and mixed-NPS intoxications and fatalities during the pandemic period by year (January 2020–March 2022).
Figure 3
Figure 3
Number of NPS single intoxications and fatalities. (a) NPS mixed intoxications and fatalities (b) during pandemic period (January 2020–March 2022). Designer Benzodiazepines, DZBP.
Figure 4
Figure 4
(a) Number of NPS single intoxications and fatalities cases; (b) NPS mixed intoxications and fatalities cases by year (January 2020–March 2022). Designer Benzodiazepines, DBZP; others (see Section 3.3 and Section 3.4).
See this image and copyright information in PMC

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